Provider Demographics
NPI:1104572940
Name:EGGENBERGER, LAURA EILEEN (LSW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:EILEEN
Last Name:EGGENBERGER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:EILEEN
Other - Last Name:EGGENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAURA SHEPHERD
Mailing Address - Street 1:6383 BINDER DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-4479
Mailing Address - Country:US
Mailing Address - Phone:719-463-5507
Mailing Address - Fax:
Practice Address - Street 1:6383 BINDER DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-4479
Practice Address - Country:US
Practice Address - Phone:719-463-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009921845104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker